KYC Form

1. Name of the Applicant

First NameLast Name

2. Father's/Spouse's Name

First NameLast Name

2a. Gender

MaleFemale

2b. Marital Status

SingleMarried

2c. Date of Birth

Date

3. Nationality

4. Status

Resident IndividualNon ResidentForeign National

5. PAN

6. Proof of Identity Submitted for PAN Exempt Cases

1. Address for Correspondence

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

2. Phone Number

Please enter a valid phone number.

3. Email

example@example.com

4. Proof of Address to be Provided by Applicant

5. Permanent Address of Resident Applicant If Different From B1 Above

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

6. Proof of Address to be Provided by Applicant

I hereby declare that the information provided in this form is accurate and complete. I confirm that any information is found incorrect and/or incomplete that leads a violation of regulations may initiate legal actions, and I accept that I am the responsible party for any and all charges, penalties and violations.

Name of the Applicant

First NameLast Name

Signature of the Applicant

Date Signed

Date

Originals verified and Self-Attested Document copies received

Name of the Authorized Signatory

First NameLast Name

Signature of the Authorized Signatory

Date Signed

Date

KYC Form

A. Identity Details

B. Address Details

C. File Upload

D. Declaration

For Office Use Only